All you really need to know about Pete Evans’ new documentary, The Magic Pill, comes up on your screen 18 seconds in, where a disclaimer tells you that “the personal stories portrayed in this film are anecdotal, and we make no claims that these experiences are typical”.
One good thing about the just-released “Lore of Nutrition“, documenting the campaign (allegedly) orchestrated by myself and others against an A-rated Professor with thousand of citations, hundreds of articles, many books, regular international speaking gigs, and constant (fawning) media coverage is that it leaves you in no doubt as to who the victim is (spoiler alert: it’s the celebrity scientist).
Last Tuesday, I gave a talk at the UCT medical school on the ethics of social media for medical professionals, which focused in part on the Health Professions Council hearings with regard to the ‘unprofessional conduct’ of Prof. Tim Noakes.
While I’ve presented a half-dozen or so talks on the philosophy and ethics of science for dietitians in the last couple of years – usually for continuing professional development (CPD) points – this one attracted more than the usual amount of attention, thanks to the imminent resumption of the Noakes hearings.
As anyone who clicked through to this piece probably knows, yesterday saw the start of a Health Professionals Council of South Africa (HPCSA) hearing to assess whether Prof. Tim Noakes is guilty of unprofessional conduct. The charge against Prof. Noakes states:
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, in that during the period between January 2014 and February 2014 you acted in a manner that is not in accordance with the norms and standards of your profession in that you provided unconventional advice on breastfeeding babies on social networks (tweet/s).
I attended all of yesterday’s session, and offer some thoughts on what transpired, below. I have not attempted to catalogue everything that happened – if you want a more detailed account, the News24 live-blog offers an accurate summary.
On futility – once more with the distinctions
It continues to exasperate that I can think of only
one person a handful of people who understand that there are (at least) two distinct issues at play in the general discussion around Noakes, LCHF and Banting. The first is the set of questions related to diet, and which is healthier for you.
In this set of questions, I’m bundling in long-term vs. short-term, treatment for obesity and diabetes, what proportion of population X are insulin-resistant and so forth. I do not, in general, comment on those issues. They are not a field of expertise for me. As I’ve repeatedly said, Noakes might well end up being a frontrunner in what eventually becomes scientific consensus.
The second set of questions relates to logic and philosophy of science, and to our responsibilities as educators, or journalists, or health professionals to discourage sloppy thinking on matters of significance (well, on all matters, but the stakes are sometimes higher than others).
So, I’ve consistently (with a few lapses, I’m sure) focused on the quality of argument that emerges from the Banting camp, rather than on the superiority of any particular conclusion. If you don’t care about those issues (you of course should), then you shouldn’t be reading my comments on them.
You certainly shouldn’t be asking me to present evidence that low-carb is bad, because that’s not what I’m claiming. You also shouldn’t be telling me that “there’s so much more bad science for the consensus” or somesuch, because maybe there is, and maybe there isn’t, but that’s not what I’m talking about. The fact that someone else (proponents of the consensus view) also does things wrong doesn’t give anyone else a free pass to be sloppy in their reasoning.
On futility II – the hearing that never happened
We spend the entire day hearing arguments about the constitution of the panel that was set to hear the case, and proceedings were eventually terminated at around 15:30 when it was agreed that the panel was improperly constituted. Proceedings will resume on November 23, assuming nothing else interferes with the process.
Should this hearing be happening at all?
I have mixed feelings about this. As with so many of our policies (and even heuristics related to social interaction), there’s a vast difference between what made sense in a pre-digital era and what makes sense now. Noakes is often to be found on Twitter – he’s written an ode to it, in fact, and his fans love him for how much he engages there.
The point of highlighting the pre/post-digital era is of course it would be irresponsible for a physician to encounter you in the street and tell you what your baby should eat, unless your advice is something rather generic and consensus-based. Even if the consensus is wrong, as Noakes thinks it is, it does sit with an advantage here – his job is to create a new consensus, after which he’ll get the same advantages.
But perhaps Twitter is different, in that it’s a broad discussion or sounding board for ideas, in which we shouldn’t expect people to view what Noakes tweets as prescriptions in the medical sense. That’s presumably what he thinks. I think he’s wrong in practice, because people do view them as prescriptions, and he should know that and act accordingly.
However, it’s possible that holding him to account for all possible consequences of his tweets does overstate the importance and role of Twitter, and also paternalise his Twitter following. For example, a non-prejudicial look at the tweet that started all the trouble is consistent with slowly weaning a child onto LCHF, perhaps in a manner that doesn’t run the risk of causing the complications the complainants in this case claim it would.
So, this case is raising very important background issues related to the appropriateness (or not) of how people with positions of influence engage on social media.It’s not going to be a waste of time, but is rather going to force everyone to resolve what I think are important issues.
It’s a great shame that many of Noakes’ supporters are struggling to see anything beyond a vendetta or bad faith here, and also that Noakes himself misses the point that it’s not about freedom of speech, but rather about the responsibilities of healthcare professionals to avoid causing harm.
He’d retort that it’s the Association for Dietetics in South Africa’s (ADSA) advice that causes the harm, but even if true (and even if he’s even representing what their advice is accurately), that’s something you demonstrate in journals, not with other people’s babies.
Is Noakes speaking “outside his field of expertise”?
One of the things that caused a fuss during the hearing was a statement made by the HPCSA’s lawyer that Noakes was operating or speaking as if he were a dietician, and that this is not his field of expertise. To briefly return to my futility theme, this was immediately leapt on by the Noakes-supporters as an attempt to suppress Noakes’ freedom to research and write on nutrition, while it was in fact nothing of the sort.
The argument was simply that because he’s operating outside of the “normal” General Practitioner (GP) set of ideas but rather as a dietician, it makes sense to include a dietician on the panel. Nevertheless, the motivated reasoning in response to this was quite something to behold, as it was immediately taken up as further evidence of the conspiracy against Noakes, who was now “not allowed” to talk about diet.
The clue as to what GPs do is in the name – they consult on a general set of health-related concerns, one of which is diet. But the claim made by the HPCSA lawyer was that Noakes was presenting himself as more than a generalist, but rather as a specialist in this area, and he should thus be assessed by a specialist also.
What was the problem with the panel composition?
The technical problem that (rightly) led to the cessation of the hearing was that the panel was lacking one particular member as per the regulations, where that member needed to be in Noakes’ profession, i.e. a GP. There was one GP on the panel, who was also a pediatrician, as well as a dietician (who I’ll return to in a moment), but there needed to be another Medical and Dental Board-registered GP present for a properly constituted panel.
What was interesting about the debate on the panel composition?
Both sides seemed intent on creating as favourable a panel as they could, which should of course be no surprise. The complainants argued strongly for the presence of a dietician, and Noakes’ lawyers argued strongly against. Noakes, of course, thinks that the dieticians exemplify bad science in this area, and he’d probably argue that they aren’t competent to assess the evidence he’ll present.
However, the problem with ruling them out is two-fold: one, it presents a circular argument, in that it assumes they are incompetent (or rather, cedes the argument regarding their competence) as reason to rule them out as assessors of the evidence; and two, if they are as incompetent as he thinks, surely it would be a simply matter to demonstrate this in the course of the hearing?
There’s the risk of a strategic blunder from the Noakes team here – the more intent they appear on trying to rule a dietician out as a panelist, the more people might wonder what they are so concerned about. If they are as scientifically backward as Noakes would have us believe, why not publicly expose that via the hearings?
The strange case of Prof. Blaauw
The dietician panelist, Prof. Blaauw, was initially considered a perfectly acceptable member of the panel, until we discovered two things about her (and the second, only rather late in the day). Over lunch, she informed the (superb) Chair of proceedings, Joan Adams, that she had once co-supervised an ethics thesis on the “media implications of Tim Noakes”. This was claimed to not impair her objectivity, and the Noakes legal team seemed happy with her, despite this knowledge.
Later on, though, we discovered that she was also a member of ADSA, whose President in fact laid the complaint against Prof. Noakes. This caused significant dissent around her suitability, as you’d expect it to given the conflict of interest.
Debate then ensued as to whether she was in fact legally part of the panel at all, as given that it had already been ruled that the panel was improperly constituted, she could not officially or automatically be considered part of a future, properly constituted panel either. Noakes’ lawyers went as far as to say that they might consider taking this issue to the High Court, if Prof. Blaauw ended up remaining on that future panel.
Bad faith and Tex bars
In an amusing turn of events, we reconvened after lunch to find that some prankster had placed Tex bars (a chocolate) on the desks in front of each panelist. Some of the Noakes supporters on Twitter immediately assumed that this was ADSA’s doing, which seemed to fit the generally uncharitable attitude on the #NoakesHearing hashtag, which also included some fat-shaming of various members of the complainant’s party.
Yes, these are emotive issues, and I can understand why people feel that someone they respect and admire for standing up to orthodoxy is being unfairly singled-out, but you don’t make an effective case for his virtue by demonstrating a lack of virtue yourselves. Even if “the other side” sometimes do the same, that does not make your doing so more appropriate either.
One of the Noakes supporters seems to have cottoned on to the reality that people like me don’t have a vendetta, but is rather simply interested in the arguments and ethics of how we debate them. But there’s still far too much ad hominem, and accusations of trolling put in terms that are themselves distinctly trollish. This is the problem of the filter bubble, as I’ve argued before, and I’ll again simply suggest that there is a conversation to be had here, and some of us are having it in good faith – whatever you might believe.
The Noakes legal team seem better prepared, and certainly appeared more effective in their rhetoric and argumentation. Now that the hearings have been extended to run for 7 days, I suspect that the complainants are going to have a difficult time competing. And, at the end of the day, Noakes will “win” on any permutation.
If he is (in the extreme scenario) struck off the roll and disallowed from practicing medicine, that’s of little consequence to his main interest, which is research and (mostly public) dissemination of findings related to diet. And, he and his supporters will have further “evidence” of his persecution.
And if he wins, that will of course serve as his – and the Banting diet’s – most significant tipping point towards public acceptance yet…
P.S.: The screenshot above is from Noakes’ Real Meal Revolution website, and you might find the last bullet-point of interest.
The 2014 “Collector’s Edition” of The Big Issue contains a number of interesting pieces, but there’s one specific piece that I’ve been looking forward to being able to share with you.
The day for doing so has finally arrived, so here is the first instalment of some thoughts on “The Digital Doctor”, contributed by Prof. Tim Noakes, and freshly uploaded to the Interwebs (thanks to @BigIssueSA on Twitter).
Participants in online communities may find their own opinions constantly echoed back to them, which reinforces their individual belief systems. This can create significant barriers to critical discourse within an online medium.
Another emerging term for this echoing and homogenizing effect on the Internet within social communities is cultural tribalism.
What the extract highlights is the problem of “groupthink”: if you surround yourself with people who say the sorts of things that agree with the sorts of things you’d like to believe are true, you all end up reinforcing each others’ beliefs, and opposing views have a difficult time getting heard.
So, it seems fairly obvious – given we know that we’re prone to weighting confirmatory evidence more favourably than disconfirmatory evidence – that someone who cares about keeping their mental furniture nearly arranged would actively seek out ways in which they might be wrong.
Supporters of Prof. Tim Noakes believes that he does exactly that, and that this is why he could famously change his mind on something so fundamental as the value of an entire category of organic compounds (carbohydrates, in case you aren’t aware).
But – and yes, I have said this before – one change of mind, no matter how fundamental or (in)famous, does not indicate anything about a general disposition, and it’s perfectly possible that Noakes (again, regardless of whether his conclusions are correct or not) has adopted (and is encouraging) sloppy thinking in this regard.
Which brings me back to The Big Issue, where it wouldn’t be unfair to describe Noakes’ contribution as a love-letter to confirmation bias, or an attempt to attract companions to occupy an echo chamber made entirely out of lard.
The piece begins with a rejection of expertise, where it turns out (according to Noakes) that an “exclusive clan who have climbed the academic ladder of success” “carefully programmed” Noakes and his fellow students to believe that what the clan professed is the “absolute truth, for now and forever”.
To help this conspiracy narrative along, these evil people with their degrees and academic credentials are given the sneery nickname of “The Anointed”, which helps to set up the us vs. them dichotomy, where the everyday folk are victims of an intellectual aristocracy, preserving their privilege at our expense.
At this point, some of us are perhaps thinking about how odd it seems that one of the people who has climbed the academic ladder about as high as one can in South Africa thinks he should be trusted, despite his own membership of this shadowy clan.
But by definition, Noakes cannot be part of The Anointed, for he has seen the light, and rejects their gospel. Perhaps he might be part of the New Reformed Anointed or somesuch, because he makes it quite explicit that the outdated dogma he was taught is false, and should be replaced by something else.
The something else, though, is never expressed with qualifications, or room for being wrong – it’s presented as absolute truth. And this is the problem – replacing one dogma with more (albeit different) dogma doesn’t help the argument for being critical of received wisdom. It simply asks you to replace received wisdom with an alternative version of the same.
There’s a problem in this simplistic account of dogma also, in that it’s only unthinking consensus that’s a problem (what we normally call dogma) – consensus isn’t a problem of necessity. So, if “The Anointed” happen to be wrong in this instance, we shouldn’t use that as an excuse for discarding the idea of expertise in general.
Experts do exist, and “common wisdom” is frequently very far from wise. Yes, “experts” can also be wrong – but as ever, we can assess arguments on their merits, rather than throw the epistemic baby of expertise out with the bathwater of a few bad arguments.
Then – crucially – we’re dealing with a complete misrepresentation of what “The Anointed” say. On the Noakes narrative, dieticians and these sneaky academic folk are pushing the line that fats are bad, and carbs at least not as bad as Noakes would have you believe (some might even say that some carbs can be good).
However, the truth doesn’t support these caricatures. It’s (now) common cause that we used to over-emphasise the dangers of fats in general. It’s (now) common cause that refined carbs are bad.
The point is that “The Anointed” have modified their position over the years, in light of the evidence. Noakes might say that they haven’t modified their position enough, or that they are ignoring some evidence or over-valuing other evidence.
But either way, they are not dogmatically pushing one line. Their arguments have evolved (whether rightly or wrong, time will tell), and it’s untrue and uncharitable to present them as inflexible purveyors of eternal “truths”.
There’s only one dogmatic voice in this conversation, and as far as I can tell, it’s not that of The Anointed.
P.S. Noakes’ solution to the problem of The Anointed is to rely on The Wisdom of the Crowds, and especially Twitter, which is “unquestionably the best way to acquire the most up-to-date information on my particular areas of scientific interest” (this is no joke. Well, I mean it’s an accurate quote.) But more on that another day.
It’s been an amusing few days for those of us who follow the social media commentary related to Prof. Tim Noakes and the Banting diet. Earlier this week, an investment strategist named Magnus Heystek posted an opinion piece titled “Is Noakes running a Ponzi scheme?“, in which Heystek uses the example of Ponzi schemes (where people get suckered into poor investments via a combination of wishful thinking and deception) to riff on the “collective delusions” that can accompany diets.
The analogy is clear, even if imperfect – in the Banting analogue, someone uncharitably disposed towards what they think of as a fad diet could argue that the flock isn’t seeing the evidence and argument objectively, but are instead being seduced by the charisma of a person or an offer into a poor investment (in their health) – just as is the case in the investment analogue.
The analogy is imperfect in the sense that – as I’ve argued in the past – Noakes seems entirely sincere, and second that he is using the proceeds of the “real” meal revolution to fund research into health, rather than for personal enrichment. But even if imperfect, it’s fair comment, and has certainly provoked debate (if not much thought).
Heystek is making a similar point to the one that I’ve repeatedly made here, which is that the evangelical fervour in support of the diet, and the casual dismissals of any opposition to it as simply uninformed, both offer little reassurance that people are thinking things through carefully, rather than being in the grip of a collective delusion (of sorts).
There’s also a sense of humour and perspective failure in the responses – from the earnest (and unfortunately snide) response of one of Noakes’s co-authors, Jonno Proudfoot, to the Twitter contingent who think Noakes should sue for defamation, the Banters need to realise that as strong as they think the evidence is for their point of view, it’s not heresy to think things aren’t as simple as all that.
By contrast, what Heystek is pointing to (and again, my main point in all these words about Noakes and Banting) is that we already know things are not simple, and that we therefore have reason to believe that evangelism is taking the place of reason when people claim they are simple.
It’s when reason is sacrificed that we encounter Noakes saying, on the one hand, that when you get personal, you’ve lost the argument; and on the other hand dismissing the arguments of critics on the grounds of their being overweight (as he’s done at least twice, with Catherine Collins and with Anthony Dalby).
His followers have learnt the lesson well, rushing to dismiss Heystek on the grounds that he, too, could lose a few kilograms (which is something Heystek himself points out in the column, but since when does the playground pay attention to details like that?).
This doesn’t mean that criticism of Noakes and Banting can’t itself sometimes be overly simplistic – nobody is immune to error. Heystek was pricking a bubble of pomposity, though, not making a scientific argument, and his column needs to be read in that context.
By contrast, this Sunday Times piece arguing that Noakes has made a u-turn on dairy is shamefully misleading (rather than simply mischievous), and really just an example of someone exploiting a popular trend to generate some traffic, with complete disregard for the evidence.
The ninth of the “10 Commandments for beginner Banting” – right there in the first edition of “Real Meal Revolution”, you are told “Control your dairy. Although dairy is good for you, it does contain carbs and can be a stumbling block for some. In your Banting beginning, perhaps avoid eating too much dairy.” (I’m leaving complexities regarding particular forms of dairy aside here – they aren’t relevant to this argument.)
Later on in the book, readers are told: “If you are not intolerant to dairy products and find they do not affect your weight loss or blood sugar levels, aim for high-fat dairy products, not skim or reduced fat, light or fat-free alternatives – they must be full-fat.”
In other words, the advice regarding dairy was always qualified advice. The authors made a mistake in compiling their green, red and orange lists of foods, though, in that greenlisted foods were described as follows: “GREEN is an all-you-can-eat list – you can choose anything you like without worrying about the carbohydrate content as all the foods will be between 0 to 5g/100g. It will be almost impossible to overdo your carbohydrate intake by sticking to this group of foods.”
That needed a “terms and conditions apply” in the case of dairy, especially because we can predict in advance that many people would go for the simple heuristic of the list (you don’t even need to read the book for the list – it’s freely available on the Real Meal Revolution website), but despite this error, there’s no evidence of any flip-flopping or change of mind for dairy, as purported by the Sunday Times.
The team simply realised that dairy being in the green list was causing people to consume more of it than was compatible with the weight-loss they were expecting, so they moved it to the orange list – in line with the qualifications above. To put it even more simply, the heuristic of the colour-coded lists wasn’t sending the right signal, so it was adapted.
And then, because people don’t pay sufficient attention to detail or relevant qualifications as they sometimes should, there was a freak-out regarding dairy suddenly being unsafe, and Noakes having “changed his mind” – so they moved it back to the green list, and re-iterated the relevant qualifications.
So, no drama there. Of course, that didn’t stop the chief lobbyist for the Banting cause (or, “science” “journalist”) Marika Sboros, from using this as an excuse to write a new piece of hyperbolic prose in defence of her hero (in which she of course links to all her old pieces, which continue being edited and added to yet carry the same permalinks as before, which seems a rather odd way to practice journalism. But I digress.).
In this new piece, much effort is directed at undermining the criticisms made by Patrick Holford in relation to Noakes. Now, contrary to how some Noakesians like to read me, I’ve never called Noakes a quack (I have said he can sound like one, though) – but I have no reservations in calling Holford a quack, and I also think he’s a mendacious one, in that he knows he’s a fraud.
There’s no need to waste time debunking Holford’s criticisms, if you are Noakes or a mouthpiece of Noakes, like Sboros. Doing so is like writing a column refuting the metaphysical views of George down at the pub, as Holford is irrelevant to science and scientific reasoning – except as an example of doing so badly.
It’s perhaps instructive, though, that even Noakes seems to think he needs to play in that market, or believes that he should – I suppose that once you become a populist, it comes with certain obligations, or at least expectations. The thing that should concern you, though, if you are a Noakes-supporter, is how defending oneself against populist criticisms can lead you to oversimplification – itself a characteristic of populism.
Sboros reports that Noakes said (it’s not an attributed quote, unfortunately) that “the clear evidence is that carbohydrate in the diet is linked to colon cancer”, in response to Dr Roger Leicester (via Holford) claiming that Banting is a risk-factor for colon cancer. Noakes also says – and I’m sure that you’ll all find this as persuasive as I do – that “that’s all unscientific twaddle”.
Except, that’s utter bullshit. It might turn out to be false – as might any hypothesis – but right now, we’ve got good evidence that high red-meat consumption is associated with increased risk of colorectal cancer. And yes, association/correlation isn’t causation, but it’s the best clue as to causation available to us in many cases – and a staple of much pro-Banting literature also (and as much as you might like to, you don’t get to cherry-pick).
Oh wait, you do get to cherry pick. Sorry, I forgot.
— Tim Noakes (@ProfTimNoakes) October 23, 2014